Medicaid expenditures for children and young adults have decreased in Illinois, but a care coordination demonstration project did not further reduce the cost of care for kids participating in the program within its first year, research from the University of Chicago at Illinois has found.
The project, known as CHECK, was established at UIC in 2014 to develop and test a comprehensive care coordination model for Medicaid-covered children and young adults with chronic health conditions living in Chicago, as well as their families. The trial included 6,259 patients with conditions like sickle cell disease, asthma, diabetes, seizure disorders and prematurity.
For the study, the researchers analyzed paid claims one year prior to participant enrollment in CHECK and one year after enrollment, from May 1, 2014 to April 30, 2017. They compared healthcare expenditures and utilization, including emergency room visits and hospitalizations, among patients enrolled in CHECK -- 3,126 individuals -- to a control group of a similar size.
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They saw a decrease in utilization among CHECK-enrolled patients -- inpatient hospitalizations decreased by 30.9% and emergency room visits by 18% -- but the reduction was similar in the control group.
The mean cost of care for CHECK patients dropped to $1,341, from $1,633. The reduction was nearly identical in the control group patients, for whom the mean cost of care dropped to $1,413, from $1,703. The difference was $292 and $290, respectively.
WHAT’S THE IMPACT
Though the first year of the CHECK program didn’t put much of a dent in Medicaid expenditures, the authors maintained that that children-focused care coordination programs have intangible benefits that may take years to fully measure.
They said that the data likely was affected by overall changes in Illinois' Medicaid program during the study period, particularly newly introduced managed Medicaid programs that likely played a role in reducing healthcare expenditures in both groups. That makes comparing the two groups a more challenging prospect than had been anticipated.
In addition to the program's effect on healthcare cost and utilization, the CHECK program also seeks to reduce school absenteeism and increase family engagement in the healthcare process. Data on these fronts is forthcoming.
Dr. Benjamin Van Voorhees, CHECK project director and senior author, said the CHECK program will continue to provide care coordination to an increasingly large group of patients, including adults, covered by Medicaid. He said the data will help in efforts to refine the program.
THE LARGER TREND
Another strategy has emerged for reducing the cost of pediatric care: switching to value-based care.
While the move to value-based reimbursement arrangements is a requirement for many adult hospitals, it’s not mandated in the world of pediatrics. But some children’s hospitals are making the switch anyway, both for financial and patient care considerations.